Role-Playing-Based Physician Training and Metabolic Outcomes Among Patients With Type 2 Diabetes: A Cluster Randomized Clinical Trial.

Importance: Global glycemic control in diabetes is suboptimal, with persistent gaps between guideline recommendations and clinical practice. Objective: To evaluate the effectiveness of a role-playing-based intensive training program for physicians in improving glycemic control among patients with type 2 diabetes. Design, Setting, and Participants: This was an open-label, 2-arm parallel, cluster randomized clinical trial conducted at 205 centers in China, with enrollment from February 13 to September 19, 2023, and 12-month follow-up completed on October 25, 2024. In phase 1, 205 physicians from qualified diabetes centers across China were enrolled from February 13 to April 29, 2023, and randomly assigned to the intensive training group (n = 103) and the regular training group (n = 102). In phase 2, 2017 patients with type 2 diabetes were enrolled from February 28 to September 19, 2023. Data were analyzed from January 1 to June 1, 2025. Interventions: One-week on-site role-playing-based intensive training (involving simulating patient roles in experiencing diabetes-related health examinations, complication scenarios, lifestyle intervention, and face-to-face conversations) vs regular training. Main Outcomes and Measures: The proportion of patients achieving a hemoglobin A1c (HbA1c) level of less than 7.0% at 6 months. The primary analysis was based on the intention-to-treat principle. Results: A total of 205 physicians (mean [SD] age, 36.2 [5.1] years; 155 women [75.6%]) and 2017 patients (mean [SD] age, 53.0 [7.0] years; 713 women [35.3%] and 1304 men [64.7%]) were enrolled, with 1009 patients in the intensive training group and 1008 patients in the regular training group. At 6 months, a significantly greater proportion of patients in the intensive training group achieved an HbA1c level less than 7.0% compared with the regular training group (58.0% [476 of 820] vs 42.9% [351 of 818]), with an adjusted between-group difference of 16.6% (95% CI, 7.2%-25.7%; P < .001). At 12 months, the difference between the intensive training group and the regular training group remained significant (60.9% [502 of 824] vs 44.6% [371 of 832]; adjusted between-group difference, 17.0% [95% CI, 7.0%-26.8%]; P < .001). The intensive group had greater reductions in body mass index (adjusted between-group difference, -0.3 [95% CI, -0.5 to -0.1]), waist circumference (adjusted between-group difference, -1.4 cm [95% CI, -2.1 to -0.8 cm]), fasting glucose (adjusted between-group difference, -6.3 mg/dL [95% CI, -10.7 to -1.9 mg/dL]), and systolic blood pressure (adjusted between-group difference, -1.5 mm Hg [95% CI, -2.9 to -0.1 mm Hg]). Serious adverse events were comparable between groups (intensive group, 2.6% [26 of 1009]; regular group, 2.4% [24 of 1008]). Conclusions and Relevance: In this cluster randomized clinical trial of role-playing-based intensive training for physicians managing type 2 diabetes, the intervention significantly improved patient glycemic control. These findings suggest a feasible strategy to narrow the guideline-implementation gap in diabetes care. Trial Registration: ClinicalTrials.gov Identifier: NCT05715307.